Tuesday 12 December 2017

Could an osteopath be the key to relieving long-term back ache?

Pain is one of the body’s responses to poor sleep
Pain is one of the body’s responses to poor sleep
Good back care is the best way to prevent long-term damage

Nina Byrnes

Advice from our GP on how to prevent and treat back pain.

Q. My mother suffered a back injury as a young woman. She used to work in a shop and put her back out lifting heavy boxes as a teenager. When the injury first occured she was on lots of painkillers and bedrest and as time has gone on, she has sought relief with various alternative practitioners - chiropracters, osteopaths, faith healers, you name it. She found acupuncture helped for a while and then in the last five years or so she has visited an osteopath regularly, who gives her relief by putting his weight on her and 'clicking' - her words - her back into place. I am concerned about the long-term effect and safety of this practice. Could you advise?

Dr Nina replies: Back pain is one of the most common causes of chronic pain in Ireland. Nearly 400,000 cases occur annually; 27pc of those who claim income support do so for back pain. It occurs most commonly in those aged 30 to 50 and occurs equally in men and women. Leading a sedentary lifestyle, being obese, poor posture or heavy lifting makes back pain more likely.

Pain can occur anywhere along the back, but one of the most common areas is the lower back or lumbosacral spine. Pain may be felt in the lower back or radiate into the buttocks, hips or down the legs. There may be numbness, pins and needles or sharp shooting pains if there is any pressure. Flexibility may be reduced and simple things like trying to put on socks or shoes can be excruciating or near impossible.

The majority of cases are due to acute strain, pain eases over days to weeks and no chronic damage has occurred. The pain itself can be quite severe, making simple things like turning, dressing, or sneezing very painful and difficult. A common cause of back pain is simple muscular strain and often you may not be aware when this occurred. Other causes of back pain can be bulging or ruptured intervertebral discs, arthritis, bony abnormalities or conditions such as osteoporosis. Weakness in the legs that gets worse over time, incontinence of urine or bowel motions or fever with back pain may indicate more severe damage and these symptoms require urgent medical attention.

The majority of people with back pain seek advice. Many will try alternative treatment such as chiropractors, osteopaths and other therapists. Others go to their GP and 70pc of them will have tried painkillers before they get there. Simple back strain is usually treated with a combination of painkillers and physiotherapy sessions and X-rays or scans are not usually necessary.

Pain due to inflammation may cause stiffness that is worse in the mornings, may be worse after periods of rest, and exercise may relieve it. This symptom is very different to that which occurs with osteoarthritis (wear and tear) as in this condition stiffness and soreness is made worse by exercise. This kind of back pain warrants further investigation and review.

X-rays will look at the bones of the back, but the better test is an MRI scan which can also look at the disc nerves and tissue surrounding the spine. If there is a nerve element to the pain there are a number of prescription drugs that may help and so if simple painkillers aren't working or physiotherapy hasn't helped, do talk to your doctor about other options. Don't seek out treatment without proper advice.

Lifestyle can help with back pain. Simple exercises like walking or swimming can be beneficial and exercise that focuses on strengthening the muscles of the abdomen and lower back will help support the spine. Pilates can be especially helpful in those with a tendency to suffer lower back pain. If there is a lot of muscle spasm applying ice or heat packs or having a warm bath can help these relax.

Good back care is the best way to prevent long-term damage.

Q. What is post-nasal drip and what can be done about it?

Dr Nina replies: Allergic rhinitis causes a sensation of blocked nose, congestion and can cause sneezing, itchy eyes and a post-nasal drip. Other symptoms include reduced taste, red eyes, mouth breathing, snoring, reduced sleep and fatigue Common triggers in winter months are house dust mite, moulds, fungal spores, and animal dander.

Rhinitis occurs in about 20pc of the population. It affects all ages. It is more common in those with a personal or family history of asthma or eczema.

Antihistamines reduce the body’s allergic response helping to limit the congestion, swelling and nasal drip associated with rhinitis. It is preferable to use those that are less sedating by day but an older sedating one may have benefits if taken at night, as disturbed sleep can be a feature of rhinitis. Steroid nasal sprays are essentially the main stay of treatment for rhinitis whenever it occurs. They act locally in the nasal passages so absorption into the body is minimal. They help reduce swelling in the nasal passages thus reducing congestion, dripping and blockage. Steroid nasal sprays are generally considered safe and they can be used on an ongoing basis if required.

It is important that remedies are used in the correct way and the correct order. When using a nasal spray aim straight back into the nose, not up or in, and breathe normally after using it. This reduced the likelihood it will irritate the lining of the nose and also ensures it stays in the nose where it needs to be. Snorting the spray back delivers it to the throat reducing its efficacy.

If sprays rinses and antihistamines aren’t working there are other prescription options and it is worth talking to your doctor or attending an allergy specialist for these.

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